Abstracts

Rationale: To evaluate the burden of comorbidities in a cohort of persons with epilepsy (PWE) by measuring the prevalence and incidence of common medical conditions. This study is part of an ongoing project (EPICARE) to assess the use of necessary and preventive care in PWE.Methods: The Ohio Medicaid claims data from 1992 to 2008 was used to form a cohort of PWE. Patients aged ? 18 years with at least one visit of a diagnosis of epilepsy (ICD-9-CM: 345.xx) or at least two visits of non-febrile convulsions (ICD-9-CM: 780.3 or 780.39), at least one pharmacy dispensing of antiepileptic drugs, at least two years of look-back period, and at least two years of follow-up period were included. Patients who enrolled in both Medicaid and Medicare programs or managed care program, who had a period of spend down, or who had less than 80% of expected enrollment were excluded. Every 2 years interval between 1994 and 2006, we identified the incident cases of epilepsy and documented the conditions that the patient presented with, or prevalent comorbid conditions, and identified new or incident conditions that developed over time. We measured the prevalence and incidence of 38 common conditions that were selected based on their commonality in the general population and their impact on the patient s outcome. Regression models were used to evaluate the rate of change in prevalence and incidence of each condition over time.Results: There were 5,430 patients who met the inclusion and exclusion criteria. The mean age was 40 years. The mean follow-up period was 6.6 years. During each interval, the patient had an average of 4 comorbid conditions. Pain was the most common condition reported. Other common chronic conditions included depression, hypertension, chronic pulmonary disease, psychosis, and lipid disorders. Among these conditions, pain, depression, hypertension, psychosis, and chronic pulmonary disease had the highest prevalence preceding epilepsy diagnosis. During the follow-up period, the prevalence of hypertension, chronic pulmonary disease, and lipid disorders continued to rise. Other conditions with significant increase in prevalence included diabetes, anemia, paralysis, hypothyroidism, obesity, peripheral vascular disorders and coagulopathy. Lipid disorders, hypertension, and diabetes had the highest rates of increase in prevalence. Contrarily, the prevalence of depression, anxiety, alcohol abuse, drug abuse, and headache decreased over time. The incidence of most conditions was stable during the follow-up period except for the incidence of pain, chest pain/discomfort, anxiety, chronic pulmonary disease, tobacco use, psychosis, headache, anemia, liver disease, hypothyroidism, and peptic ulcer disease, which lessened over time.Conclusions: PWE have several concurrent somatic and psychiatric conditions. Most of these conditions exist prior to epilepsy diagnosis. The prevalence of several conditions rises over time. An assessment of the use of necessary and preventive care for these conditions, therefore, is critically important.